CANDIDATE APPLICATION BLANK Reference Code / Sr.

#
(to be filled prior to first interview)

SKILLS: Total Experience (Yrs.Mths):

Technical Expertise In: Experience

(Yrs.Mths): Photo

Domain/Functional Expertise In: Experience

(Yrs.Mths):

I. Personal Details
* Name: Mr/Mrs/Ms Mitra Kaustav Kumar *
(as in your passport) Last First Middle

Religion: Hindu Mother Tongue: Bengali Date of Birth: 22/06/1988

Present Address: 62, Old Police Line Road, Gorabazar

City: Berhampore State: West Bengal Pincode: 742101 Home Tel No:

Business Tel No: Mobile: 9051487076 Personal Email Id: kaustavonline@yahoo.com

Permanent Address:
62, Old Police Line Road, Gorabazar

City: Berhampore State: West Bengal Pincode: 742101 Tel No: ###

Emergency Contact details Name: Kalyan Kumar Mitra Relationship: Father

Current Address: 62, Old Police Line Road, Gorabazar

City: Berhampore State: West Bengal Pincode: 742101 Home Tel No: ###

PAN #: BBUPM7200E Existing HDFC Saving Account #: Branch Name:

Driving License #: Expiry Date:

Passport #: Place of Issue: Expiry Date: Citizenship:

Have you ever applied for a Work Permit/Visa: Y/N N l When: Country:

Have you ever been rejected a Work Permit/Visa: Y/NN If Y, When: Country:
When: Country:

Languages Known Written Spoken Languages Known Written Spoken

English Yes Yes Hindi

Yes Yes

Bengali Yes Yes

II. Family Background

Name Date of Birth Occupation Name Date of Birth Occup
Kalyan Kumar Mitra Child 1(male/female)
Service
Late Madhuri Mitra Child 2 (male/female)
NA
Spouse(marriage date) Child 3 (male/female)

III. Education (Matriculation Onwards In Reverse Chronological Order)

Year of Passing
Qualification University/Board Percentage(GPA) Scholastic Achievment, If Any
From To

B-TECH West Bengal University Of Technology

2006 2010 7.67

Higher Secondary WBCHSE 2004 2006 90.4

ICSE CISCE 2003 2004 90.17

IV. Professional Certification/Training

Certification/Training[Soft/Technical] Year Certification/Training[Soft/Technical] Year
CANDIDATE APPLICATION BLANK Reference Code / Sr. #
(to be filled prior to first interview)
 CANDIDATE APPLICATION BLANK Reference Code / Sr. #
(to be filled prior to first interview)

V. Previous Employment History (Reverse Chronological Order)

Duration Responsibity (nature
Compensation
Organization Designation of resp, team size, managerial
(Cost to Company)
From To role, etc.)

VI. Currrent Organisation Structure (Indicate Your Position)

VII. Professional Achievements(Awards/Recognition)

VIII. Extra Curricular Activities

IX. Have You Been Interviewed By Capgemini Earlier? Y/N N

If Y, When (mm/yy): Interviewer's Name: What was the outcome?

X. Do you have Relatives/Friends in Capgemini? Y/N Y

If Y, Name: Kingshuk Bardhan Relationship: Friend Yrs.Mths Known: 20 years

XI. References
Professional Professional Personal Personal
Name

Relationship

Years Known

Company Name
Title or
Occupation
Home Tel No

Business Tel No

XII. Current Salary Break-Up

Monthly Annual Notice period
Basic Medical working days
HRA LTA
Conveyence PF Expected CTC
Others (Pls Specify) Gratuity Lacs
1 Bonus
2 Others (Pls Specify) Readiness to work on Night Shift
3 1 Yes No (Please circle)

Monthly Gross 2
3 Readiness to work on Support Projs.
Annual Gross Yes No (Please circle)

Declaration
 CANDIDATE APPLICATION BLANK Reference Code / Sr. #
(to be filled prior to first interview)

I, hereby declare that the above information provided by me is true and accurate to the best of my knowledge. I was never arrested by police or have a criminal record. Any falsification
of this information will hold me liable to the action taken against me by the organisation as per it's prevailing rules and regulations.

Kolkata 29/09/2010 SIGNATURE:

Kaustav Kumar Mitra